Thank you for your interest in volunteering with Mason’s Toy Box. Please complete the online form below. If you would like to print out and e-mail a volunteer application form, you can download it here. Please scan and send all applications and waivers to email@example.com. Your Information Your Name (First and Last) Date of Birth (MM/DD/YYYY) Address (Street, City/Town, State, Zip) Phone Number (###-###-####) Alternate Phone Number (###-###-####) Email Address Emergency Contact Information Emergency Name (First and Last) Relationship Address (Street, City/Town, State, Zip) Phone Number (###-###-####) Alternate Phone Number (###-###-####) Do you have previous volunteer Experience? (List Name of Organization, Year and what you did) What is your highest level of education? What languages do you speak? Do you have any physical limitations? (If yes, please describe) Do you have a location preference for volunteer work? Charlottesville, VARichmond, VA Waiver This Release and Waiver of Liability, herein known as the release, between the you, herein known as volunteer, and Mason’s Toy Box Foundation, Inc., an organization dedicated to providing joy to hospitalized children over the holiday season, and each of its co-founders, directors, andvolunteers, herein known as organization. Volunteer desires to provide volunteer services for organization and engage in activities related to serving as a volunteer. Volunteer understands that the scope of the volunteer’s relationship with organization is limited to a volunteer position and that no compensation is expected in return for any services or products provided by volunteer; and that volunteer is responsible for his/her own insurance and/or any medical attention, vaccinations, or otherwise that may be required or result from volunteer services. 1. Waiver and Release: I, the volunteer, release and forever discharge and hold harmless organization and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the services I provide the organization. I fully understand and acknowledge this release discharges the organization from any liability or claim that I may have against the organization with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to the organization or occur while I am providing services. 2. Cost: I, the volunteer, fully understand and acknowledge that any and all cost I chose to incur either in providing services, coordinating events, making, buying, or distributing products related to the mission of the organization is solely and exclusively my responsibility. I understand that the organization has no liability to repay any cost regardless loss the benefit to the organization. This includes compensation and/or interest incurred for labor, printed material, supplies, and any other cost which may be associated with providing volunteer services to the organization. 3. Insurance: Further I fully understand and acknowledge that the organization does not assume any responsibility or obligation to provide financial or other assistance, including but not limited to medical, health, or disability benefits, auto insurance, or insurance of any nature in the event of accident, injury, death, or property loss. I expressly waive any such claim for compensation or liability on the part of the organization. 4. Medical Treatment: I hereby release and forever discharge the organization from any claim whatsoever which arises or may hereafter arise on account of any first aid or medical services rendered in connection with an emergency during the time of my volunteer services. 5. Assumption Risk: I understand that the services I preform for the organization may include activities that may be hazardous in some way despite safety efforts including, but not limited to, lifting of boxes, driving a motor vehicle, possible exposure to illness in hospitals, possible exposure to elements, and any other activity preformed as a volunteer. I fully understand and accept that as a volunteer I expressly assume all risk of harm or injury from these and all activities and release the organization of all liability for to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to the organization or occur while I am providing services. 6. Media Release: I grant and convey to the organization all right, title, and interest in any photograph, likeness, video, image, or audio recording made of me, my likeness, or my voice made by the organization or others representing, acting in behalf of, or news outlets covering the organization while I am providing volunteer services or in attendance of any organization function, official or unofficial. 7. Monetary Donations: I fully understand and agree that as a volunteer I am not to accept cash donations in any denomination unless preauthorization has been granted by Kelley Kassay, President, for a specific donation or event. Otherwise all donations must directed to the website for an online paypal donation. In the event a donation is collected it must be immediately delivered to an authorized Foundation Board member for deposit. 8. Appropriate Behavior: I fully understand that when I am volunteering my services to the organization my behavior is a reflection of the organization and hence must be in a fashion that does not tarnish the reputation. Whilst acting in any capacity for the organization restricted behaviors include, but are not limited to, profanity, belligerence, intoxication, dress in a way deemed inappropriate for the audience, and behaviors otherwise deemed a poor reflection of the organization. I acknowledge acceptable behavior may vary by venue and shall be at the discretion of the event host or coordinator. 9. Other: I expressly agree that as a volunteer I agree that this release is intended to be broad and all inclusive as permitted by Virginia State law. This release shall be governed by and interpreted in accordance with the laws of the Commonwealth of Virginia. In the even that any portion or portions herein are deemed invalid, unenforceable, or unlawful, the enforceability of the remaining document remains intact and shall not be affected. I express my full acceptance and understanding of this release by signing below. I am signing this document fully informed and without confusion or coercion. I have read and agree to this waiver.